John Cena makes his way out to a very mixed reaction, as per usual, and talks about all the opinions he's heard this week from fans, doctors, etc. He says he is not a doctor or a lawyer, and his job is to show up at Extreme Rules and defend the WWE title.

Vickie Guerrero interrupts the champ, and says that Extreme Rules isn't just a normal night, and talks about the extreme stipulations surrounding Brock Lesnar's match with Triple H, and the World Heavyweight title at the pay-per-view. She brings out the challenger, and Ryback makes his way to the ring. Vickie says because John Cena is the champion, he gets to pick the stipulation first – he says maybe they should stand in the ring and just whine about all the things that have been "unfair" to Ryback in the last year. Cena says he doesn't care, and it may as well be a panties-on-a-pole match.

Vickie then says Ryback has the chance to pick the stipulation, since the champ doesn't care. Ryback says that Cena is hurt, and can't even take a step. But he's not fighting John Cena tonight, and is smart enough to walk away from a fight when the time is wrong. He calls Cena's pride and ego his achilles' heel, and in two weeks everyone – including John – will know that "Ryback Rules". The match is officially a Last Man Standing match.

Randy Orton vs. Damien Sandow

Sandow sings a song mocking Randy Orton on the way down to the ring, and The Viper attacks him as soon as he hits the ring. They roll to the outside and Orton throws Sandow into the announce table, then into the apron, then off the barricade. He tries for the Hangman's DDT off the apron, but Sandow slams Orton into the barricade, and the two brawl back into the ring. Randy goes to work stomping away at Sandow's limbs as we head to a commercial break.

After the break, Sandow is in control with a side headlock. Orton powers out of the hold and hits two back-to-back stiff clotheslines. Hangman's DDT connects, followed by the RKO for a three-count.